Sentiment tested on single-payer health care

Is health care a human right that should be provided through a Medicare-type program for people of all ages?

CYNTHIA McCORMICK

Is health care a human right that should be provided through a Medicare-type program for people of all ages?

Many local voters will have the opportunity to weigh in Tuesday on a non-binding referendum that will be on the ballot in a number of Massachusetts communities, including nearly all towns on the Cape and Martha's Vineyard.

Known as Question 4 in most towns — or questions 5 and 6 in some Vineyard towns and Orleans — the ballot item is backed by the groups Mass Care and Cape Care, which have called for a single-payer health insurance program in Massachusetts and Barnstable County.

The current health-care system is too fragmented and expensive to work effectively, according to Dr. James Garb and Mary Zepernick, members of the Cape Care Coalition.

Even with the state's much heralded health reform law, too many people are uninsured or underinsured, Garb said. He said the current system of many competing health insurance plans could bankrupt health care through bloated administrative costs.

"Single payer is the logical way to go," Garb said.

Under a single-payer system, one agency — be it a Medicare-type program or a non-profit trust fund — writes the insurance reimbursement checks, said Alan Sager, professor of health policy and management at the Boston University School of Public Health.

Health insurance companies gradually would be factored out of the health-care system, he said. "A single payer means every patient is covered and every hospital gets adequate revenue."

The ballot initiative also asks voters to oppose any laws penalizing the uninsured for failing to obtain health insurance. Under the state health-reform law, people who do not have health insurance are subject to fines, payable through their income tax filings.

It will appear as Question 5 in Orleans, Aquinnah, Chilmark, Edgartown, Gosnold, Oak Bluffs and West Tisbury and as Question 6 in Tisbury.

It will not be on the ballot in Barnstable, Sandwich and Mashpee, because organizers didn't have time to organize a ballot-petition drive in those towns, Zepernick said.

If it were on the ballot in his district, State Rep. Jeffrey Perry, R-Sandwich said he wouldn't vote for it.

"I think that's a huge step toward socialism and increasing the cost of health care," Perry said. "It's not something we can afford to do."

There are other ways to keep health costs down, Perry said, such as limiting the ability of people to sue for malpractice and having a "serious discussion" about what kinds of coverage should be provided.

"The government would not change the practice of medicine," Sager said. "The doctors would not be public servants."

A single-payer system will reduce the cost of delivering and paying for health care and restore peace of mind, Garb said. "There wouldn't be the co-pays. There wouldn't be the deductibles. People wouldn't have to worry about what would happen with a serious illness."

Think of a single-payer system as Medicare for all age groups but more comprehensive, Garb and Zepernick said.

While the Massachusetts Taxpayers Foundation has not taken an official position on the ballot initiative, its president said he is "very skeptical" about a single-payer system.

"It means a lot of different things to a lot of different people," said the business-funded group's president, Michael Widmer, who supported the mandatory health insurance law currently in effect. "If the notion is government can take over the entire system and manage it more efficiently and responsibly than the current system, I'm very dubious of that proposition."

The Cape Care Coalition has plans to present a bill in January that would create a single-payer system just for Barnstable County. Garb and Zepernick called it a demonstration project that is uniquely suited to the Cape's defined geographic boundaries.

They say funding would come from such government sources as Medicare and Medicaid, and a tax, either on income or property.

Individuals also would pay what Garb described as a low premium.

Cape Codders could elect not to participate in the countywide single-payer program, said Dr. Brian O'Malley, of Provincetown, a member of the Cape Care Coalition steering committee. People still could use insurance plans available through work or elsewhere, he said.